Self-retaining retractor

ABSTRACT

Retractor assemblies and methods of using them to retract tissue. A retractor assembly as described herein may include first and second arms pivotally coupled and each arm formed of a plurality of stacked and separated plates, spaced to define a gap therebeween, providing strength while affording a reduction in weight of the retractor assembly. The retractor assembly may also include a ratcheting locking mechanism.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.16/841,658, filed Apr. 6, 2020, titled “SELF-RETAINING RETRACTOR,” nowU.S. Pat. No. 11,213,286, which is herein incorporated by reference inits entirety.

INCORPORATION BY REFERENCE

All publications and patent applications mentioned in this specificationare herein incorporated by reference in their entirety to the sameextent as if each individual publication or patent application wasspecifically and individually indicated to be incorporated by reference.

FIELD

Described herein are retractors (e.g., retractor apparatuses, includingretractor devices and retractor assemblies). These retractors may besurgical tools used for surgery, including surgery upon live subjects,which may be humans or other animals, including mammalian animals,living or dead. For example, the apparatuses described herein may beused for surgery on a living human or non-human animal, and/or forrecovery of organs from living or non-living humans or non-humananimals.

BACKGROUND

Self-retaining retractors are widely used in the surgical field.Typically, retractors have a limited spread or opening ability andinclude at least one cross member to allow for adjustment. This limitedrange of motion and/or additional cross members can restrict, shrink,and/or block the visibility of the working field available to themedical staff to perform the respective procedure. Accordingly, it isdesirable to have a retractor that can provide better visibility and awider range of movement while additionally being simple to manipulateand lock into position.

SUMMARY OF THE DISCLOSURE

Described herein are improved retractor apparatuses (e.g., devices,systems, assemblies, etc.) and methods of using them. Retractors asdescribed herein provide a number of advantageous elements, which may beused singly or in combination. A first improvement relates to retractorassemblies having multi-plate construction for each of a first arm and asecond arm pivotally coupled together, which can lighten the overallretractor assembly while increasing its strength. The multi-plateconstruction may include two, three, four or more plates aligned to forma first arm or a second arm. The multi-plate construction includes aspace (e.g., gap, slot, etc.) between each successive plate. The spacepermits insertion of the retractor assembly between other devicespresent within the surgical field. Alternatively, the presence of thespace between successive plates of the arm may permit portions of aretractor blade or handle to insert itself therebetween, or may permitother devices present within the surgical field to be at least partiallyinserted therebetween.

The arms of the retractor assemblies may be configured to include one ormore receiving wells, which may receive fasteners, which may couple oneor more retractor blades of varying types to the retractor assemblies.Any of the one or more receiving wells may further be configured as areceiving slot, which may permit coupling of retractor blades or otherdevices or tools used during a surgical procedure. Whether coupled via areceiving well or a receiving slot, a retractor blade may be coupledrotatably or adjustably, and may further be capable of adjustment whilestill connected to the retractor assembly. In some variations, thecoupling may be made via a quick connect pin or other quick releasingdevice.

Another improvement to retractor assemblies is improved lockingmechanisms (e.g., ratcheting lock) for securing a first arm of theretractor assembly at a desired angle with respect to a second arm ofthe retractor assembly, where the first arm and the second arm arepivotally coupled to each other. The angle at which the first arm andthe second arm are secured with respect to each other about the pivotalcoupling, may be any angle, e.g., from about 5 degrees to about 180degrees or may be any angles less than about 180 degrees. A variety oflocking mechanisms may be used, including, but not limited to aneccentric cam lock mechanism, or a quick release locking mechanism,amongst others. It is desirable to open and secure the retractorassembly more easily during the surgical procedure, and permitadjustment during the course of the procedure. The locking mechanismsdescribed herein permit locking at any selected angle within the rangeof operation of the retractor assembly. In some variations, the lockingmechanism may be a self-locking mechanism such as the quick releasemechanism (e.g., a quick release plate or plates) as described herein,or the like. The quick release locking mechanism may be disposed alongeach of the first and the second arm, near the pivot coupling point, andmay include a pawl, which may be urged against a set of ratchet teeth ofan opposite arm to permit opening and closing of the retractor assemblyin a controllable, selective and self-locking (e.g., preventing closing,allowing opening) manner. The pawl may be urged against the set ofratchet teeth of the opposite arm by a bias (e.g., biasing strip orspring), which retains the pawl in engagement with the set of ratchetteeth. The pawl may be released from engagement by deflecting the biasagainst a restraining pin, to move the quick release mechanism away fromthe set of ratchet teeth, thereby disengaging the pawl.

Yet another improvement is provided by a retractor assembly having afirst arm and a second arm, where each of the first and the second armsgenerally have a C-shape or conformation. The C-shape can provide a moreopen surgical field and better visibility to the surgical personnel.Each arm may include several sections connected, each at angle relativeto the succeeding section, may have a curved shape or may have amulti-curved shape, providing the C-shape to the retractor assembly.

Accordingly, in a first aspect, a retractor assembly is providedincluding a first arm pivotally coupled to a second arm at a pivot; anda locking mechanism configured to lock the first arm and the second armat a selected angle therebetween.

In some variations, the selected angle at which the first arm and secondare locked relative to each other may be about 180 degrees or less. Thelocking mechanism may be configured to lock the first arm and the secondarm at any angle from 5 degrees to 180 degrees.

In some variations, the first arm and the second arm may each include afirst plate, a second plate, and a slot therebetween.

In some variations, the first arm and/or the second arm may furtherinclude one or more receiving wells. In some embodiments, at least oneof the receiving wells of the first arm and/or the second arm mayinclude an extended receiving slot. In some variations, the retractorassembly may further include a retractor blade coupled to a receivingwell by a fastener. In some embodiments, the retractor blade may furtherinclude a sub-assembly including a self-positioning arm to which theretractor blade may be connected by a fastener, which may be rotatable,non-rotatable, or may be a quick releasing fastener.

In some variations, the locking mechanism may be a self-lockingmechanism including a first quick release mechanism disposed along thefirst arm and a second quick release mechanism disposed along the secondarm. In some variations, the first quick release mechanism may engage afirst set of ratchet teeth disposed on a first end of the second arm andthe second quick release mechanism may engage a second set of ratchetteeth disposed on a first end of the first arm. In some variations, thefirst quick release mechanism and the second quick release mechanism maybe biased against the respective set of ratchet teeth by a bias.

In another aspect, a retractor assembly is provided including a firstarm pivotally coupled to a second arm at a pivot, wherein each of thefirst arm and the second arm is a C-shaped arm. In some variations, thefirst arm and/or the second arm may include two or more sections, eachdisposed at an angle relative to each other, thereby forming theC-shaped arm.

In some variations, the angle between sections may be from about 110degrees to about 145 degrees, and further wherein the angle is measuredwithin a C-shape formed by the arm.

In some variations, the first arm and/or the second arm may furtherinclude one or more receiving wells. In some embodiments, at least oneof the receiving wells of the first arm and/or the second arm may be anextended receiving slot. In some variations, the retractor assembly mayfurther include a retractor blade coupled to a receiving well by afastener.

In some variations, the retractor assembly may further include aself-locking ratcheting locking mechanism configured to lock the firstarm and the second arm at a selected angle therebetween, preventingclosing, while permitting opening of the two arms relative to eachother.

In yet another aspect, a retractor assembly is provided including: afirst, arm pivotally coupled to a second arm at a pivot, where the firstarm and the second arm each include a first plate, a second plate, and aslot therebetween.

In some variations, the first arm and/or the second arm may furtherinclude one or more receiving wells. In some embodiments, at least oneof the receiving wells of the first arm and/or the second arm mayinclude an extended receiving slot. In some variations, the retractorassembly may further include a retractor blade coupled to a receivingwell by a fastener. In some embodiments, the retractor blade may furtherinclude a sub-assembly including a self-positioning arm to which theretractor blade may be connected by a fastener, which may be rotatable,non-rotatable, or may be a quick releasing fastener.

In some variations, the retractor blade may be rotatably coupled to thereceiving well, and is configured to insert at least a portion of theretractor blade within the slot.

In some variations, the retractor assembly may further include aself-locking, ratcheting locking mechanism configured to lock the firstarm and the second arm at a selected angle therebetween.

For example, in general, a retractor device (e.g., retractor assembly)as described herein may include: a C-shaped first arm; a C-shaped secondarm, wherein the first arm is pivotally connected to the second arm at apivot; and a ratcheting lock configured to lock the first and secondarms relative to each other to prevent them from reducing the anglebetween the arms until a release is activated, while allowing the anglebetween the first and second arms to be increased.

In some variations the retractor assembly includes: a C-shaped first armthe first arm comprising a first plate and a second plate that areseparated from each other by a first spacing distance; a C-shaped secondarm the second arm comprising a third plate and a fourth plate that areseparated from each other by a second spacing distance, wherein thefirst arm is pivotally connected to the second arm at a pivot; aratcheting lock configured to lock the first and second arms relative toeach other to prevent them from pivoting to reducing the angle betweenthe arms until a release is activated, while allowing them to be pivotedto increase angle between the first and second arms.

The C-shaped arms described herein are generally C-shaped, so as to forman opening to access the retracted tissue. The C-shape refers to an armhaving a side (e.g., the side facing the opposite arm) that has agenerally concave profile; the C-shaped arm may extend (top to bottom)through a general angle of curvature that is between 20 degrees and 270degrees (e.g., measured from a midpoint of the circle approximatelysubtended by the curvature of the arm). For example, the C-shaped armmay be slightly curved (approximating a parenthesis), or very curved(approximating a textual C). The two arms may have different angles ofcurvature or the same angles of curvature. The angle of curvature may besmooth or segmented (as shown in the illustrated examples of thefigures). For example, the first arm and/or the second arm may comprisetwo or more (e.g., 3, 4, 5, 6, etc.) sections, each disposed at an anglerelative to each other, thereby forming the C-shaped arm.

As mentioned, the arms may each comprise a plurality of plates separatedfrom each other by spacing distances. In some variations the plates eachhave a generally C-shape, and are stacked against each other with a gapbetween them. The gap may be between about 0.5 mm and about 2 cm (e.g.,between 0.5 mm and about 1.5 cm, between about 0.5 mm and about 10 mm,between about 0.5 mm and about 7.5 mm, etc.).

The ratcheting lock may include one or more first quick release plates;for example, the ratcheting lock may include a first quick release platedisposed along the first arm and a second quick release plate disposedalong the second arm. The quick release plate may include a pawl at oneend and a bias (or a connection to a bias) at the other end; the pawlmay include one or more teeth for engaging with a set of ratchet teethon the opposite arm. In some variations the quick release plate includesa set of ratcheting teeth that engage with a pawl element on theopposite arm.

For example, a first quick release plate may engage with a first set ofratchet teeth disposed on a first end of the second arm and the secondquick release plate engages a second set of ratchet teeth disposed on afirst end of the first arm. In some variations only a single quickrelease plate (ratcheting connection) is used. The first quick releaseplate and the second quick release plate may be biased against therespective set of ratchet teeth by a bias (e.g., a Nitinol wire, band,etc., or a rubber/elastic band, wire, etc.). Any appropriate bias may beused, including a spring or the like.

The quick release plate may form the release that is configured torelease the ratcheting lock to allow the first arm and the second arm toclose, so that the angle between the first arm and the second arm isreduced. The release may be a protrusion (e.g., the head of the T-shapedquick release plate) that extends laterally from the gap in the platesof the arm from which the quick release plate is slidably coupled.

The first quick release plate may generally be slidably disposed betweenthe plates forming the first arm and wherein the second quick releaseplate is slidably disposed between the plates forming the second arm.

Any of the retractors described herein may include one or more tissueengaging members (e.g., fingers, hands, retractor blades, retractorshields, etc.). The tissue engaging elements may generally couple to thedistal ends (opposite of the pivot connecting the arms) of the arms, ina receiving well (e.g., through hole) in which it may be mounted (e.g.,attached by a screw, post, etc., including pivotably mounted.

For example, a retractor assembly may include: a curved first arm thefirst arm comprising a first plate and a second plate that are separatedfrom each other by a first spacing distance; a curved second arm thesecond arm comprising a third plate and a fourth plate that areseparated from each other by a second spacing distance, wherein thefirst arm is pivotally connected to the second arm at a pivot, furtherwherein the curved first and second arms face each other so that thefirst arm forms a concave first curve and the second arm forms a concavesecond arm (this curve may be formed by generally straight segmentedregions connected at an angle); a ratcheting lock configured to lock thefirst and second arms relative to each other to prevent them frompivoting to reducing the angle between the arms until a release isactivated, while allowing them to be pivoted to increase angle betweenthe first and second arms; and a first quick release plate slidablydisposed between the first plate and the second plate, wherein the firstquick release plate is biased against a set of ratchet teeth in thesecond arm, further wherein a portion of the first quick release plateforms the release.

Also described herein are methods of using the retractors describedherein. For example, a method of retracting tissue may include:positioning a first arm of a retractor assembly against a first portionof a tissue; positioning a second arm of the retractor assembly againstthe second portion of the tissue; ratcheting the first arm relative tothe second arm to retract the tissue so that the tissue is accessiblebetween a C-shaped portion of the first arm and a C-shaped portion ofthe second arm, wherein a ratcheting lock in the retractor assemblyprevents the angle between the first arm and the second arm from beingreduced while permitting the angle to be increased by pivoting the firstarm away from the second arm; and inserting one or more tools at leastpartially into a space formed between a first c-shaped plate and asecond C-shaped plate forming the first arm.

Any of these methods may include releasing the ratcheting lock to allowthe first arm to pivot closer to the second arm and reduce the anglebetween the first and second arms by sliding a first quick release platebetween the first and second C-shaped plates of the first arm, removinga pawl on the first quick release plate from a set of ratchet teeth onthe second arm. Releasing the ratcheting lock may comprise deflecting abias on the quick release plate.

BRIEF DESCRIPTION OF THE DRAWINGS

A better understanding of the features and advantages of the methods andapparatuses described herein will be obtained by reference to thefollowing detailed description that sets forth illustrative embodiments,and the accompanying drawings of which:

FIG. 1 is a photographic representation of a top perspective view of aself-retaining retractor in a first position according to someembodiments of the disclosure.

FIG. 2 is a photographic representation of a top view of theself-retaining retractor of FIG. 1 in a second position according tosome embodiments of the disclosure.

FIG. 3 is a photographic representation of a top view of aself-retaining retractor having multiple retractor blades with handlesin exemplary positions according to some embodiments of the disclosure.

FIG. 4 is a photographic representation of a top perspective view of aself-retaining retractor having multiple retractor blades in exemplarypositions according to some embodiments of the disclosure.

FIG. 5 is a photographic representation of a top perspective view of aself-retaining retractor having multiple retractor blades in exemplarypositions according to some embodiments of the disclosure.

FIG. 6 is a photographic representation of a side perspective view ofthe self-retaining retractor of FIG. 5 according to some embodiments ofthe disclosure.

FIG. 7 is a photographic representation of a top perspective view of aself-retaining retractor according to some embodiments of thedisclosure.

FIG. 8 is a photographic representation of a top perspective view of aself-retaining retractor having a self-positioning arm according to someembodiments of the disclosure.

FIG. 9 is a side perspective view of a portion of the self-retainingretractor of FIG. 8.

FIG. 10A is a graphical representation of a top perspective view of aself-retaining retractor having a quick release plate according to someembodiments of the disclosure.

FIG. 10B is a graphical representation of a side perspective view of aretractor blade attached to an arm of a self-retaining retractoraccording to some embodiments of the disclosure.

FIG. 11 is a graphical representation of an exploded view of aself-retaining retractor according to some embodiments of thedisclosure.

FIGS. 12A and 12B are graphical representations of a top perspectiveview and a side perspective view respectively of a plate of an arm of aself-retaining retractor according to some embodiments of thedisclosure.

FIGS. 13A and 13B are graphical representations of a top perspectiveview and a side perspective view respectively of a plate of an arm of aself-retaining retractor according to some embodiments of thedisclosure.

FIGS. 14A to 14C show examples of a perspective view, a top view and aside view of one variation of a first quick release mechanism (e.g.,quick release plate) according to some embodiments of the disclosure.

FIGS. 15A to 15C show examples of a perspective view, a top view and aside view of one variation of a first quick release mechanism (e.g.,quick release plate) according to some embodiments of the disclosure.

FIG. 16 is a graphical representation of a portion of a quick releaseplate and elements of the ratchet of a plate of an arm of the retractorassembly according to some embodiments of the disclosure.

FIGS. 17A and 17B are graphical representations of a top and side viewof a guide bar of the quick release plate according to some embodimentsof the disclosure.

FIGS. 18A-18C are graphical representations of top and side views ofretractor blades and attachment thereof according to some embodiments ofthe disclosure.

FIGS. 19A-19D are graphical representations of another retractor bladeaccording to some embodiments of the disclosure.

FIG. 20 and FIG. 21 are opposite faces of a retractor assembly having aquick release ratcheting mechanism according to some embodiments of thedisclosure.

FIG. 22 is a photographic representation of a retractor assembly havinga quick release ratcheting mechanism according to some embodiments ofthe disclosure, which is shown in a first opened position.

FIG. 23 is a photographic representation of the retractor assembly ofFIG. 22, having a quick release ratcheting mechanism shown in a secondopened position.

FIGS. 24A-24C are photographic representations of sub-assemblies forretractor blades according to some embodiments of the disclosure.

DETAILED DESCRIPTION

As used herein, the term “and/or,” when used in a list of two or moreitems, means that any one of the listed items can be employed by itself,or any combination of two or more of the listed items can be employed.For example, if a composition is described as containing components A,B, and/or C, the composition can contain A alone; B alone; C alone; Aand B in combination; A and C in combination; B and C in combination; orA, B, and C in combination.

As used herein, the term “about” means that amounts, sizes,formulations, parameters, and other quantities and characteristics arenot and need not be exact, but may be approximate and/or larger orsmaller, as desired, reflecting tolerances, conversion factors, roundingoff, measurement error and the like, and other factors known to those ofskill in the art. When the term “about” is used in describing a value oran end-point of a range, the disclosure should be understood to includethe specific value or end-point referred to. Whether or not a numericalvalue or end-point of a range in the specification recites “about,” thenumerical value or end-point of a range is intended to include twoembodiments: one modified by “about,” and one not modified by “about.”It will be further understood that the endpoints of each of the rangesare significant both in relation to the other endpoint, andindependently of the other endpoint.

For purposes of this disclosure the term “coupled” (in all of its forms:couple, coupling, coupled, etc.) generally means the joining of twocomponents (electrical or mechanical) directly or indirectly to oneanother. Such joining may be stationary in nature or movable in nature.Such joining may be achieved with the two components (electrical ormechanical) and any additional intermediate members being integrallyformed as a single unitary body with one another or with the twocomponents. Such, joining may be permanent in nature, or may beremovable or releasable in nature, unless otherwise stated.

FIGS. 1-24, show a retractor assembly, generally denoted as a retractorassembly 10. Reference numbers are reiterated for similar elementsthroughout FIGS. 1-24. Retractor assembly 10 includes first and secondarms 14, 18 pivotally coupled and each having at least a first plate 22a, 22 b and a second plate 26 a, 26 b. While two plates are shown in theFIGS. 1-24, the retractor assembly 10 is not so limited and there may be2, 3, 4 or more plates in retractor assembly 10, each separated by aslot 30 between each plate of the arm. The first and second plates 22 a,22 b, 26 a, 26 b of each of the first and second arms 14, 18 are spacedto define the slot 30, that is, plate 22 a overlays plate 26 a of firstarm 14 and plate 22 b overlays plate 26 b of the second arm 18, and slot30 is formed between the respective plates of the first arm 14 andsecond arm 18. Use of a first plate and second plate (and possibly more)to construct arm 14, 18 permits the retractor to be lighter for itsstrength, due to the multiple plates. Additionally, the presence ofslot(s) 30 in each arm permit insertion of the retractor assemblybetween other devices or other devices may be inserted in or through aslot. The retractor assembly 10 further comprises a. plurality ofreceiving wells 34 defined by each of the first and second arms 14, 18.One or more of the receiving wells 34 may be a receiving slot 38. Theretractor assembly 10 also includes a locking mechanism, which may beany of the locking mechanisms described herein, and their like. Thelocking mechanism, which may be any locking mechanism described hereinor the like, of retractor assembly 10 can lock arm 14 and arm 18 at aselected angle relative to each other for optimized surgical field size.The locking mechanism may lock the first arm 14 and the second arm 18 atan angle relative to each other of about 5 degrees; about 10 degrees;about 25 degrees; about 45 degrees; about 60 degrees; about 75 degrees;about 90 degrees; about 135 degrees; about 145 degrees; about 170degrees; about 180 degrees; or any angle therebetween. In someembodiments, the locking mechanism may permit locking the first arm 14and the second arm 18 from about 10 degrees to about 180 degrees, about15 degrees to about 180 degrees, about 30 degrees to about 180 degrees,about 60 degrees to about 180 degrees, about 75 to about 180 degrees,about 90 to about 180 degrees, about 110 degrees to about 180 degrees orany range selected therebetween, preventing further closing (whilegenerally allowing further opening) of the retractor. In someembodiments, the locking mechanism may permit locating the first arm 14and the second arm 18 at an angle that is 180 degrees or less.

Each receiving well 34 may be configured to receive a fastener 60. Thefastener 60 may be secured by a plurality of bolts 64 and washers 68, apressure fitting or a quick connect mechanism such as a pin. The bolts64 and washer 68 may be used to space apart the first and second plates22 a, 26 a of the first arm 14 and the first and second plates 22 b, 26b of the second arm 18 to form a slot 30, e.g., a space between thefirst and the second plates of each arm 14, 18. The slot 30 extends thelength of each of the first arm 14 and the second arm 18 and isconfigured to receive retractor blades 48 or other tools, such as, butnot limited to other surgical tools or a camera. In some examples, theslot 30 may allow a handle 102 of a retractor blade 48 to be movable invarious directions, e.g., adjusted to differing positions within asurgical field (See FIGS. 3 and 4). In some examples, the slot 30 may bespaced by washers (see FIG. 9). In other examples, the slot 30 may bespaced by tube expansion, rolling, and flaring to secure a ball withinthe tube. The slot 30 may be any width to allow various portions of theretractor blades 48 to move between the first and second plates 22 a, 22b, 26 a, 26 b.

The retractor assembly 10 may have one or more, typically two or moreretractor blades 48 attached to the first arm 14 and the second arm 18.The retractor blades 48 may each be any retractor blade describedherein.

The first arm 14 and the second arm 18 each includes a first end 80, themidsection 84, and a second end 88. The first end 80 may be positionedat a predetermined angle relative to the midsection 84, and themidsection 84 may be positioned at a predetermined angle relative to thesecond end 88. In some examples, the predetermined angles may be withinthe range of about 110 degrees to about 160 degrees, about 110 degreesto about 150 degrees, about 110 to about 15 degrees, or about 130degrees to about 145 degrees, measuring within the interior anglebetween the sections of the arm. In FIG. 12 A, this is illustrated foran exemplary angle of 135 degrees. In other examples, the predeterminedangles may be within the range of about 145 degrees to about 160degrees. The angles of the respective first end 80, midsection 84,second end 88 of the first arm and second arm may be modified to obtaina larger (e.g., more open) or a smaller (e.g., more restricted) incisionsite as desired for a particular application. The angles of therespective first end 80, midsection 84, second end 88 of the first armand second arm may form a C-shaped surgical working region defined bythe arms. A more open incision site can provide facilitated movementsand speed a surgery. Alternatively, a smaller opening (smaller distancebetween retractor blades 48 of the first arm 14 and second arm 18 maypermit surgical manipulations to be performed, reducing surgicalrecovery. It will be understood that the lengths and angles of the firstend 80, the midsection 84, and the second end 88 may vary whilemaintaining the same proportion to allow for variation in size of theretractor assembly 10. For example, different retractor assemblies maybe sized appropriately for adult human surgical procedures or forjuvenile or perinatal human surgical procedures. Larger or smallerretractor assemblies may be produced for operability upon animalssmaller or larger than humans. The angles may be the same or different,and it will be understood that there may be more than two angles formedby one of the first arm 14 and second arm 18 without departing from thescope of the present disclosure. Additionally, it will be understoodthat there may be more sections of the first arm 14 and the second arm18 and the design is not limited to the three sections mentioned here.For example, the first and second arms 14, 18 may include four sections,five sections, six sections, etc. without departing from the scope ofthe present disclosure. In other examples, the first and second arms maybe non-linear with one continuous section, e.g., the first arm and/orthe second arm may be a curved or multi-curved shaped arm.

A retractor assembly 10, like any described herein, including the firstand second arms 14, 18 and the retractor blades 48 (including 248, 348),may be made entirely of surgical grade steel or any other material,including metals or ceramics, that may be clinically acceptable. Theslot 30 allows for the retractor assembly 10 to be lighter than otherretractors of the same material while still being sturdy. Additionally,for ease of use, the retractor blades 48 and self-positioning arm 120,described below, may be operably coupled to the first and second arms14, 18 and the receiving wells 34 by ball and socket connections toallow a wide range of movement of the retractor blades 48. In someexamples, the fasteners 60 and bolts 64 may be replaced by press and/orquick connect fittings to allow easy removal and adjustment of theretractor assembly 10. This eliminates the possibility of loss of bolts64 or washers 68 in a medical situation that could cause additional timeloss. Fasteners 60 and bolts 64 may further include rotatable fasteners,including bolts, washers, press or quick connect fittings permittingrotation of the attachments (self-positioning arm 120, retractor blades48 and the like) about the receiving well 34.

Turning to specific exemplary retractor assemblies, in FIGS. 1-2, theretractor assembly 10 includes one embodiment of a locking mechanism, aneccentric quick-lock cam lever 42 configured to lock the first andsecond arms 14, 18 in a selected position. The operation of theretractor assemble may be understand by referring to FIG. 1. However,any of the retractor assemblies described herein may operate similarly,even if differing lock mechanisms and differently configured pivotregions are used. In FIG. 1, the retractor assembly 10 is shown in afirst position. The retractor assembly 10 includes the first arm 14 andthe second arm 18. The first arm 14 includes the first plate 22 a andthe second plate 26 a. The first plate 22 a is positioned in line withthe second plate 26 a, and the first and second plate s 22 a, 26 adefine some of the plurality of receiving wells 34. Similarly to thefirst arm 14, the second arm 18 includes the first plate 22 b and thesecond plate 26 b. The first plate 22 b is positioned in line with thesecond plate 26 b, and the first and second plates 22 b, 26 b define theremainder of the plurality of receiving wells 34.

Each of the receiving wells 30 may be coupled with retractor blades 48,as shown in FIG. 1. The blades 48 may be positioned so that one side ofthe blade 48 is slidable between the first plate 22 a, 22 b and thesecond plate 26 a, 26 b within the slot 30. In some examples, theretractor blades 48 may be bolted to one of the first arm 14 and thesecond arm 18. In other examples, the retractor blades 48 may beconfigured to couple to the retractor assembly 10 using a pressfastener. When the retractor assembly 10 is in the first position, theretractor blades 48 may be positioned to overlap.

Retractor blades 48 may additionally or alternatively be coupled with areceiving slot 38 positioned on a midsection 84 of each of the first arm14 and the second arm 18. It is contemplated that the receiving slot 38may be replaced by receiving wells 34 or disposed at different locations(e.g., different from the midsection 84) along the length of the firstarm 14 and/or second arm 18 without departing from the scope of thepresent disclosure. The receiving slot 38 may be configured to allow aretractor blade 48 to move laterally along one of the first arm 14 andthe second arm 18 without detaching the retractor blade 48 from theretractor arm 14, 18, or to be refastened, changing the angle of thehandle 102 of the retractor blade with respect to the retractor arm 14,18. It is also contemplated that a receiving slot 38 may be used inplace of any of the plurality of receiving wells 34 without departingfrom the scope of the present disclosure, allowing multiple receivingslots 38 to be used on the retractor assembly 10.

Referring now to FIG. 2, the retractor assembly 10 is shown in a secondposition. The second position, as shown in FIG. 2, may be an expandedposition, where, in use, the retractor blades 48 are configured toretain a surgical incision open, permitting access to the underlyingtissues and organs. The eccentric quick-lock cam lever 42 is configuredto secure the retractor assembly 10 in the first position (FIG. 1) andthe second position (FIG. 2). The cam lever 42 can also secure theretractor assembly 10 in any position between the first position and thesecond position. This provides a wide range of movement that allows theretractor assembly 10 to be used in various applications. The cam lever42 operates about a pivot 90 where the first portion 22 b of the secondarm 18 is stacked over the first portion 22 a of the first arm 14. Thispositions the second portion 26 b of the second arm 18 under the firstportion 22 a of the first arm 14 and the second portion 26 a of thefirst arm 14 on the furthest away from the cam lever 42. It iscontemplated that the stacking of the first and second portions 22 a, 22b, 26 a, 26 b is exemplary only and may be adjusted or alternatedwithout departing from the scope of the present disclosure.

To unlock the retractor assembly 10 for movement, the cam lever 42 maybe raised and rotated in a first direction to loosen a pivot 90. Thefirst arm 14 and the second arm 18 are then rotatable about the pivot90. When the desired position is reached, the cam lever 42 is rotated ina second direction, where the second direction is opposite the firstdirection. When the cam lever 42 is tightened, the cam lever 42 is thenlowered to sit flush with one of the first arm 14 and the second arm 18.As shown in FIG. 2, the retractor assembly may be able to create anopening up to about 21 inches wide, with a vertical dimension of about 6inches, when the cam lever 42 has been locked in a fully opened (e.g.,180 degrees) position. As the angle of the first arm 14 and the secondarm 18 decreases from 180 degrees, a larger vertical dimension to theretracted region may be obtained, which decreasing the width of thesurgical opening proportionately.

Referring now to FIGS. 3-6, in some other embodiments of a retractorassembly 10, the first arm 14 may define an arched guide 94 configuredto guide the movement of the second arm 18. The guide 94 may beconfigured to receive a pin 98 operably coupled to the second arm 18 andmay limit the movement of the first and second arms 14, 18 about thepivot 90 when adjusting the cam lever 42. When the pin 98 is flush withone end of the guide 94, the retractor assembly 10 is in the firstposition. When the pin 98 is flush with the other end of the guide 94,the retractor assembly 10 is in the second position. The length of theguide 94 may be determined by the desired amount of movement of thefirst arm 14 and the second arm 18.

As shown in FIGS. 3 and 4, various forms of retractor blades 48 may beused. In some examples, the retractor blades 48 may include handles 102.When the handle 102 defines a channel 106, the channel may be operablycoupled to one of the receiving wells 34 or receiving slots 38 by one ofthe fasteners 60. The fastener 60 may include a winged bolt 110 for easyand rapid adjustment of the retractor blade 48 along the length of thechannel 106 of the handle 102. In other examples, the retractor blade 48may include a plurality of extensions 114 rather than a single face. Itwill be understood that other variations of retractor blades 48 may beused with the retractor assembly 10 without departing from the scope ofthe present disclosure. Additionally, as shown in FIGS. 5 and 6, theretractor blades 48 may be operably coupled with any one of thereceiving wells 34 or the receiving slot 38. The retractor blades may beoperably coupled to one of the first portions 22 a, 22 b or one of thesecond portions 26 a, 26 b to provide connections for the retractorblades 48 that position them extending upward from the retractorassembly 10 or downward from the retractor assembly 10. Additionally, itwill be understood that any number of retractor blades 48 may be used,based on the desired application of the retractor assembly 10, withoutdeparting from the scope of the present disclosure.

Referring now to FIGS. 7-9, other embodiments of a retractor assemblyincorporating an eccentric quick-lock cam lever 42 are shown. FIG. 7shows a retractor assembly (with no retractor blades attached) that maybe adjustably locked as described above for the similar retractorassembly of FIGS. 1-2. The retractor assembly 10 may have any of thefeatures of a retractor assembly as described above, and furtherincludes a first arm 14 having a first end 80, midsection 84, second end88. Each of the first end 80, midsection 84, and second end 88 containsa receiving slot 38, and at the intersection of the first end 80 withthe midsection 84 and the intersection of the second end 88 with themidsection 84, each arm 14, 18, includes a well 34. The eccentricquick-lock cam lever 42 is located at the pivot 90, and controls theextent of opening of the first arm 14 from the second arm 18. In thisembodiment, there is no widened region around pivot 90 on first arm 14and second arm 18. This configuration may provide more desirablevisibility in some applications.

In FIG. 8, a retractor assembly 10 like that of retractor assembly 10 ofFIG. 7 is shown which may include a self-positioning rotating arm 120that may be rotatably coupled to one of the plurality of receiving wells34 of the first arm 14. The self-positioning arm may include a pluralityof receiving wells 124 configured to operably couple retractor blades 48to the self-positioning arm 120. In some other examples, theself-positioning arm 120 may be fixed to prevent rotation about thereceiving well 34. The retractor blades 48 may further be rotatableabout the receiving wells 124 of the self-positioning arm 120 to allow awide range of movement and visual options. In FIG. 8, the first arm 14includes a self-positioning arm 120 including two sets of retractorblades 48, and the second arm 18 includes a self-positioning arm 120attached via well 34 of the second end of arm 18, where theself-positioning arm includes two sets of retractor blades. A thirdretractor blade 48 is also attached via well 34 of the second end of arm18.

In FIG. 9, a portion of the retractor 10 of FIG. 8 shows the variety ofretractor blades mentioned above. The rotatable coupling of theself-positioning arm 120 through receiving well 34 is shown, as well asthe two sets of rotatable retractor blades 48, each rotatably coupledthrough receiving wells 124 of self-positioning arm 120, extendingdownward in this view. The two sets of retractor blades 48, may each bea retractor blade 248, having individual finger extensions for holdingback incised tissues. There may be 2, 3, 4, or more finger extensions,and the length of the finger extensions may vary. In some embodiments,each of the finger extensions of a retractor blade 248 may be selectedto have a length suitable for the depth of the desired surgical incisionand may be from about 0.1 inch to about 5 inches, or any lengththerebetween. In some other embodiments, the length of the fingerextension may be longer than 5 inches. Extending above the arm 14 is thethird retractor blade 48. As seen here, the third retractor blade 48 maybe a cupped single blade 348. The cupped portion of the retractor blade348 may be useful to hold back intestines or other organs whenretrieving organs for transplantation, and may have no sharp edges atall. The cupped retractor blade 348 and the retractor blade 248, havingfinger extensions may be used in tandem, for example, where theretractor blade 248 holds the surgical incision open and the cuppedretractor blade 348 holds portions of the intestines aside during organretrieval surgical procedures. The cupped retractor blade 348 may beparticularly useful in organ retrieval.

FIGS. 10A-B to 16 and 19-22 show yet another embodiment of a retractorassembly 10, which includes a quick release ratcheting mechanism 50 asthe locking mechanism. FIG. 10A shows a retractor assembly, partiallyassembled to show some of the details of the quick release mechanism(shown as a quick release plate) 50. As shown in FIG. 10A, plate 22 a ofarm 14 is shown, while only the lower plate 26 b of arm 18 is shown, sothat details of quick release plate 50 may be seen. Quick release plate50 includes a guide bar 52, which fits into a slot (not shown) of plate26 b of arm 18. The guide bar 52 assists in aligning the quick releaseplate 50 along the arm 18 as it is engaged or repositioned. Biasingelement 54, which may be a nitinol wire, a spring, an elastic member, orthe like, is biased against restraining pin 56 to hold the quick releaseplate against the pivot 90 (not shown here). Tabs 55 are configured tobe grasped while readjusting the angle of the arms 14, 18 to each other.The locking mechanism including the quick release plate may be aself-locking mechanism. The locking and adjustment mechanism is asdescribed in greater detail below in FIG. 16. Generally, the quickrelease plates 50, present on each of arm 14 and 18, may be engagedagainst a portion of the opposing arm (not shown in FIG. 10A) to selectand lock a selected position of the arms 14, 18 with respect to eachother. Advantages of the quick release plates 50 include the ability topull the retractor arms open without any requirement to make a separatelocking gesture; the retractor assembly stays open, e.g., the lockingmechanism is self-locking. The quick release plate of FIGS. 10A-B to 16and 19-22 aid in the speed of use and general facility in operation. Thetwo arms are held adjustably together at pivot region 92, using afastener 94 at the pivot. The fastener may be any kind of fastenerpermitting rotatable motion of arm 14 relative to arm 18, and may be abolt, a pin, a press fitting, a quick connect fitting, a telescopingbarrel fitting, or any suitable fastener permitting rotation as is knownin the art. The retractor assembly 10 of FIG. 10A may have any of theother features of a retractor assembly of FIGS. 1-9 and 11-25, andsimilar features have similar reference numbers.

FIG. 10B shows a side perspective view of the retractor blades 248attached to self-positioning rotating arm 120, and connected via the arm120 to arm 14 via a fastener 60 inserted into well 34 of arm 14. FIG.10B shows the two plates 22 a and 26 a of arm 14. The finger extensions148 of the retractor blade 248 have a length selected to be optimizedfor the surgical use intended, as described.

FIG. 11 is an exploded view of the partially assembled retractorassembly 10 of FIG. 10A and 10B. Plates 22 a and 26 a of arm 14 may bealigned and fastened at pivot 90 (fastener not shown), with a firstquick release plate 50 interspersed. Pins 56 may pass through plates 22a and 26 a to place quick release plate 50 in tension, by biasing strip54. The pawl 58 is the portion of quick release plate 50 that engageswith a set of ratchet teeth of the opposite arm 18 (not shown). Thesecond quick release plate 50′ is disposed on plate 26 b of arm 18, andthe guide bar 52 fits through guide slot. Pawl 58 engages the set ofratchet teeth 96 of plate 26 a of arm 14, and the quick release plate 50is held in tension against the set of ratchet teeth 96 by biasing strip54 and pins like pins 56 (not shown here). Also shown is the attachmentof self-positioning rotating arm 120 via a rotatable coupling pin 72,and retractor blades 248 attached to the self-positioning arm 120.

FIG. 12A is a top perspective view of dimensions and features of anexemplary plate 22C of an arm 14 or 18. At least one of the two, three,or more plates aligned to form an arm 14 and/or arm 18 may be like theplate of FIG. 12A. Plate 22C is like plate 26 a of FIG. 11 and FIG. 10A.The dimensions shown in FIG. 12A are in inches. For example, the firstend 80 may have a length, excluding the set of ratchet teeth 96, ofabout 5.50 inches; the midsection 84 may have a length of about 5.0inches, and the second end 88 may have a length of about 4.5 inches,exclusive of the rounded end of the plate. However, the dimensions shownare but one example, and many variations may be suitably chosen. Theangle between the first end 80 and midsection 84 may be selected to beabout 135 degrees, and the angle between the midsection 84 and thesecond end may be about 135 degrees, and form a C-shaped opening. FIG,12B shows the side perspective view of the plate of FIG. 12A, and showsthat it may have a thickness of about 0.105 inches.

FIG. 13A is a top perspective view of dimensions and features of anexemplary plate 22D of an arm 14 or 18. At least one of the two, three,or more plates aligned to form an arm 14 and/or arm 18 may be like theplate of FIG. 13A. Plate 22C is like plate 22 a or 26 b of FIG. 11 andFIG. 10A. The dimensions shown in FIG. 13A are in inches. For example,the first end 80 may have a length, excluding the rounded regionextending past pivot point 90, of about 5.50 inches; the midsection 84may have a length of about 5.0 inches, and the second end 88 may have alength of about 4.5 inches, exclusive of the rounded end of the plate.However, the dimensions shown are but one example, and many variationsmay be suitably chosen. The angle between the first end 80 andmidsection 84 may be selected to be about 135 degrees, and the anglebetween the midsection 84 and the second end may be about 135 degrees,and form a C-shaped opening. Plate 22D has a guide slot 62 into whichthe guide bar of a quick release plate 50 or 50′ may be disposed, andthe length of the guide slot, exclusive of rounded ends, may be about1.3 inches. FIG. 13B shows the side perspective view of the plate ofFIG. 13A, and shows that it may have a thickness of about 0.105 inches.

FIGS. 14A-C show perspective views of the first release mechanism 50.FIG. 14A shows a perspective view and FIG. 14C a top view, of the firstquick release plate 50, including quick release tabs 55 (forming arelease on each side of the arm) extending outward from both sides ofmechanism 50, and a bias (e.g., biasing strip 53), which may be anitinol wire, an elastic membrane, a spring or any other elastic membermaterial. Guide bar 52 projects slightly upwardly on one side (and mayextend on the opposite side as well, not shown) from the horizontalplane of the quick release plate 50, and is configured to fit into aguide slot 62 on the plates forming the arm 14 or 18. The guide bar maybe integral to the quick release plate or attached, e.g., secured to thequick release plate 50 by one or more fasteners 53, which may be anysuitable kind of fastener such as a screw, or other fastening device.The quick release plate may include a pawl 58, which is configured tomate with the set of ratchet teeth 96 of a plate of arm 14 and/or arm18. When engaged with the set of ratchet teeth 96, pawl 58 preventsmovement of arms 14 and 18 relative to each other in one direction(e.g., clockwise) while allowing relatively easy rotation in theopposite direction. When released by the quick release, the pawl maypermit rotation by disengaging from the set of ratchet teeth 96 of theplate of arm 14, 18 to permit closing of the retractor assembly; theretractor may be opened by the application of fairly low force, allowingthe pawl to ratchet over the set of ratcheting teeth. Contoured cutawayregion 57 may be configured to prevent interference and to permitrotation when the quick release plate disengages pawl 58 from the set ofratchet teeth 96. Similarly, the set of ratcheting teeth may only extendpartially around the circular end of the portion of the arm includingthe set of ratcheting teeth, allowing the device to freely move the armsat some angles.

FIG. 14C shows a side view of quick release plate 50, showing the guidebar 52, extending outward on both sides from the horizontal plane of thequick release plate 50. The quick release plate (including the guidebars) may be lubricated for easy movement within the arms or they mayinclude a lubricious surface (e.g., coating, etc.).

FIGS. 15A-C show perspective views of the second release mechanism 50′.FIG. 15A shows a perspective view and FIG. 15C a top view, of the secondrelease mechanism 50′ including quick release tabs 55 extending outwardfrom both sides of mechanism 50′, and a bias (e.g., biasing strip 53),which may be a nitinol wire, an elastic membrane, a spring or any otherelastic member material. Guide bar 52 extends upwardly and below (notshown) from the horizontal plane of the second release mechanism 50′,and is configured to fit into guide slots 62 of plates forming arm 14 or18. The guide bar 52 is secured to the second release mechanism 50′ byone or more fasteners 53, which may be any suitable kind of fastenersuch as a screw, or other fastening device. The second release mechanism50′ incudes pawl 58, which is configured to mate with the set of ratchetteeth 96 of a plate of arm 14 and/or arm 18. When engaged with the setof ratchet teeth 96, pawl 58 prevents movement of arms 14 and 18relative to each other in one direction (e.g., “closing”), but permitsrelatively easy movement in the opposite (e.g., “opening”) direction, asdescribed above for FIGS. 14A-14C. When released by the second releasemechanism 50′ (release), e.g., by driving/sliding the quick releaseplate away from the pivot and compressing the bias, the pawl maydisengage from the ratcheting teeth 96 of the plate of arm 14, 18 topermit closing of the retractor assembly. Contoured cutaway region 57 isconfigured to prevent interference and to permit rotation when the quickrelease plate disengages pawl 58 from the set of ratchet teeth 96. FIG.15C shows a side view of quick release plate 50′, showing the guide bar52, extending outward on both sides from the horizontal plane of the qsecond release mechanism 50′.

FIG. 16 shows a portion of the quick release plate 50 or 50′, engagedwith the set of ratchet teeth 96 portion of a plate of arm 14 or arm 18(only the ratchet teeth of the arm are illustrated; see FIG. 12 for anillustration of the entire arm). The pawl 58 of mechanism 50, 50′ mateswith the individual teeth 98 of the set of ratchet teeth 96, which areangular teeth having a more nearly vertical face on the clockwise facingfacet of each tooth, and a less vertical face on thecounterclockwise-facing facet of each tooth. The pawl 58 is held intension by a bias (e.g., biasing strip 53) that pushes against therestraining pin 56 when at rest. The angles of the pawl 58 arecomplementary to the angles of the teeth 98 of the set of ratchet teeth96 and when released from biasing (e.g., tension) against the set ofratchet teeth 96, permit counterclockwise movement of the set of ratchetteeth 96, controllably to a single tooth advance at a time, depending onthe extent of relief of tension of the pawl 58. The relief from biasingforce may be provided by pulling on tabs 55 to deflect biasing strip 54to a second more deflected position against restraining pin 56, andmoving the pawl out of engagement with the set of ratchet teeth 96.Thus, quick and controllable adjustment of the extent of pivoting aboutpivot 90 may be provided. In some variations, the biasing strip mayextend further than shown in FIG. 16; for example the biasing strip 55may extend the full length (shown in FIG. 16 as 2.5 mm) of the quickrelease plate. As mentioned, the dimensions shown are for illustrationonly; other dimensions may be used.

In normal operation, the ratcheting mechanism of the quick release plateand the opposite arm (e.g., the set of ratcheting teeth) may allow thearms to be opened with the application of very little force, but resultin locking of the arms to prevent “closing” of the jaws formed by thearms. The extent of movement about pivot 90 may be controlled by thepitch of the toothed advance. For this example, the advance may bedefined as a 5-degree pitch to the clockwise facing facet and aneight-degree pitch to the counterclockwise facing facet of the teeth ofthe set of ratchet teeth 96. When the retractor 10 is no longer needed,the biasing strip 54 may be deflected further to a third final deflectedposition against restraining pin 56 such that pawl 58 no longer engagesthe set of ratchet teeth 96 at all, and the arms 14 and 18 may bebrought back to a closed position.

FIGS. 17A and B show the top and side views of guide bar 52, which fitsinto guide slot 62 of the plates of arms 14, 18 (not shown). The guidebar 52 is configured to move along the guide slot 62 as the quickrelease plate is deployed, keeping the quick release plate aligned withthe arms 14, 18 and the set of ratchet teeth 96.

FIG. 18A is a top view of a retractor blade assembly configured as ahand or set of fingers, including an attachment bar 118, which in someembodiments may be a self-positioning rotating arm 120, having areceiving well 124 for coupling via a fastener to an arm 14, 18 of theretractor assembly 10. Another receiving well 124′ shows a fastenerattaching the retractor blade 248, having fingered extensions. FIG. 18Bis a side view of the retractor blade 248. FIG. 18C is a side view ofthe finger extensions 148 of the retractor blade 248 of FIG. 18A, wherethe length of the finger extensions may be any suitable length asdescribed herein.

FIGS. 19A-19D show a perspective view, a back view, and a top view of aretractor blade 348. FIG. 19D is a section view through line A-A of FIG.19C. This variation of a retractor blade is shown as saddle-shaped andmay be used to hold back and/or tissue against the relatively smoothsurface.

FIG. 20 shows a first side of another retractor assembly 10 having arm14 and arm 18. The arms 14, 18 each include two plates. Arm 14 has anupper plate 22 a and a lower plate 26 a, separated by slot 30 (notshown). Arm 18 has an upper plate 22 b and a lower plate 26 b separatedby slot 30 (not shown). In some other embodiments of the retractorassembly 10 of FIG. 20, there may be more than two plates, e.g., threeplates, four plates or more, each separated from each other by a slot30. Arms 14, 18 each have a first end 80, a midsection 84 and a secondend 88, which may have any dimensions as described herein. There may beadditional sections as well, as described herein. Additionally, whilearms 14, 18 are shown having discrete changes of angles between eachsection, the arms may instead have a continuous curve or multiplecurves. Arms 14, 18 form a C-shaped region. Arms 14, 18 have receivingwells 34 and receiving slots 38 configured to permit attachment ofretractor blades or other components such as but not limited to acamera. The pivot region of retractor 10 of FIG. 20 has a bolt 94 as apivot fastener permitting rotation of the two arms 14, 18, permittingadjustable opening and closing. The position of arms 14, 18 relative toeach other is adjustable using quick release plates 50, 50′, each ofwhich is stacked within the plates of the respective arm and configuredto engage a corresponding the set of ratchet teeth 96 of the other arm,as described above for FIG. 16. The quick release plates 50, 50′ may belike any quick release plates 50, 50′ described herein. The quickrelease tabs 55 of the quick release plates 50, 50′ are visible,extending from the region of the slot 30, and the guide bar 52 isvisible within the guide slot 62 of each upper plate visible here. FIG.21 shows the opposite face of the retractor assembly 10 of FIG. 20, andtherefore has all of the same features. Notable in this view is thewasher portion of the pivot fastener 94

FIG. 22 shows yet another embodiment of a retractor assembly 10including quick release plates 50, 50′. While not labeled, the retractorassembly 10 of FIG. 22 may have any of the features as described forFIGS. 20 and 21. However, the retractor assembly of FIG. 22 has adifferent pivot fastener 94 from that of FIGS. 20 and 21, having a pressfastener instead of a bolt and washer fastener. In FIG. 22, theretractor assembly 10 is shown having a self-positioning rotatable arm120 with two sets of retractor blades 248, attached to arm 14. Theself-positioning rotatable arm 120 is releasably attached to arm 14 viaquick connect 66 fastener, which is inserted into a receiving well 34,not visible here. Retractor assembly 10 of FIG. 22 has both aself-positioning rotatable arm 120 with two sets of retractor blades 248and a retractor blade 348 attached to arm 18. As can be seen in FIG. 22,the retractor blade 348 and self-positioning arm(s) 120 may bepositioned as needed, and the retractor blades 248 may also be rotatablyattached to self-positioning arm 120. The retractor assembly 10 of FIG.22 may have additional or different retractor blades attached atdifferent location upon the retractor assembly as described herein; thespecific implements shown in FIG. 22 are not intended to be limiting theretractor assembly in any way. In FIG. 22, the retractor assembly 10 isshown in a first partially open configuration. The retractor assembly 10of FIG. 22 may be opened further or less as described in FIG. 16. FIG.23 shows the retractor assembly of FIG. 22 in a second fully openedconfiguration, showing the extent of surgical working area possible withthe retractor assembly 10.

FIGS. 24A-24C show views of a sub-assembly 130 including aself-positioning arm 120, retractor blades 248 (showing fingerextensions 148) and a quick connect fastener pin 66. Self-positioningarm 120 is rotatable about receiving well 124, where quick connectfastener pin 66 is shown. In this embodiment, the retractor blades 248are aligned with the self-positioning arm 120 but in other embodiments,the retractor blades 248 may be connected to the self-positioning arm120 via fasteners at receiving wells 124 that permit rotation about theself-positioning arm. The finger extensions 148 of retractor blades 248may be selected to have any suitable number and to have any suitablelength as described herein. In FIG. 24A, the self-positioning arm 120 isrotated to have an angle of less than 180 degrees between the two halvesof the arm 120. In FIG. 24B the two halves of the self-positioning arm120 are disposed at 180 degrees (flat) relative to each other. FIG. 24Cshows perspective views of two sub-assemblies 130 of retractor blades248, self-positioning arm 120 and quick connect fastener pin 66.

Described herein are retractor assemblies, which can provide numerousadvantages for a user because of their lightweight design and wide rangeof maneuverability. Each of the locking mechanisms described hereinallow fast and easy adjustment of the width of the retractor assembly1.0. The slot(s) 30 provide(s) a lightweight design that increases theease of handling and maneuvering the retractor assembly 10. Thereceiving wells 34 and the receiving slot 38 provide for numerousassemblies based on the desired use, and the quick connect design of thefasteners may provide easy and safe removal and addition of retractorblades 48. The angled design also provides a wider view of the incisionand provides easier access and sightline without the hindrance of extrasupport bars across the retractor.

When a feature or element is herein referred to as being “on” anotherfeature or element, it can be directly on the other feature or elementor intervening features and/or elements may also be present. Incontrast, when a feature or element is referred to as being “directlyon” another feature or element, there are no intervening features orelements present. It will also be understood that, when a feature orelement is referred to as being “connected”, “attached” or “coupled” toanother feature or element, it can be directly connected, attached orcoupled to the other feature or element or intervening features orelements may be present. In contrast, when a feature or element isreferred to as being “directly connected”, “directly attached” or“directly coupled” to another feature or element, there are nointervening features or elements present. Although described or shownwith respect to one embodiment, the features and elements so describedor shown can apply to other embodiments. It will also be appreciated bythose of skill in the art that references to a structure or feature thatis disposed “adjacent” another feature may have portions that overlap orunderlie the adjacent feature.

Terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting of the invention.For example, as used herein, the singular forms “a”, “an” and “the” areintended to include the plural forms as well, unless the context clearlyindicates otherwise. It will be further understood that the terms“comprises” and/or “comprising,” when used in this specification,specify the presence of stated features, steps, operations, elements,and/or components, but do not preclude the presence or addition of oneor more other features, steps, operations, elements, components, and/orgroups thereof. As used herein, the term “and/or” includes any and allcombinations of one or more of the associated listed items and may beabbreviated as “/”.

Spatially relative terms, such as “under”, “below”, “lower”, “over”,“upper” and the like, may be used herein for ease of description todescribe one element or feature's relationship to another element(s) orfeature(s) as illustrated in the figures. It will be understood that thespatially relative terms are intended to encompass differentorientations of the device in use or operation in addition to theorientation depicted in the figures. For example, if a device in thefigures is inverted, elements described as “under” or “beneath” otherelements or features would then be oriented “over” the other elements orfeatures. Thus, the exemplary term “under” can encompass both anorientation of over and under. The device may be otherwise oriented(rotated 90 degrees or at other orientations) and the spatially relativedescriptors used herein interpreted accordingly. Similarly, the terms“upwardly”, “downwardly”, “vertical”, “horizontal” and the like are usedherein for the purpose of explanation only unless specifically indicatedotherwise.

Although the terms “first” and “second” may be used herein to describevarious features/elements (including steps), these features/elementsshould not be limited by these terms, unless the context indicatesotherwise. These terms may be used to distinguish one feature/elementfrom another feature/element. Thus, a first feature/element discussedbelow could be termed a second feature/element, and similarly, a secondfeature/element discussed below could be termed a first feature/elementwithout departing from the teachings of the present invention.

Throughout this specification and the claims which follow, unless thecontext requires otherwise, the word “comprise”, and variations such as“comprises” and “comprising” means various components can be co-jointlyemployed in the methods and articles (e.g., compositions and apparatusesincluding device and methods). For example, the term “comprising” willbe understood to imply the inclusion of any stated elements or steps butnot the exclusion of any other elements or steps.

In general, any of the apparatuses and methods described herein shouldbe understood to be inclusive, but all or a sub-set of the componentsand/or steps may alternatively be exclusive, and may be expressed as“consisting of” or alternatively “consisting essentially of” the variouscomponents, steps, sub-components or sub-steps.

As used herein in the specification and claims, including as used in theexamples and unless otherwise expressly specified, all numbers may beread as if prefaced by the word “about” or “approximately,” even if theterm does not expressly appear. The phrase “about” or “approximately”may be used when describing magnitude and/or position to indicate thatthe value and/or position described is within a reasonable expectedrange of values and/or positions. For example, a numeric value may havea value that is +/−0.1% of the stated value (or range of values), +/−1%of the stated value (or range of values), +/−2% of the stated value (orrange of values), +/−5% of the stated value (or range of values), +/−10%of the stated value (or range of values), etc. Any numerical valuesgiven herein should also be understood to include about or approximatelythat value, unless the context indicates otherwise. For example, if thevalue “10” is disclosed, then “about 10” is also disclosed. Anynumerical range recited herein is intended to include all sub-rangessubsumed therein. It is also understood that when a value is disclosedthat “less than or equal to” the value, “greater than or equal to thevalue” and possible ranges between values are also disclosed, asappropriately understood by the skilled artisan. For example, if thevalue “X” is disclosed the “less than or equal to X” as well as “greaterthan or equal to X” (e.g., where X is a numerical value) is alsodisclosed. It is also understood that the throughout the application,data is provided in a number of different formats, and that this data,represents endpoints and starting points, and ranges for any combinationof the data points. For example, if a particular data point “10” and aparticular data point “15” are disclosed, it is understood that greaterthan, greater than or equal to, less than, less than or equal to, andequal to 10 and 15 are considered disclosed as well as between 10 and15. It is also understood that each unit between two particular unitsare also disclosed. For example, if 10 and 15 are disclosed, then 11,12, 13, and 14 are also disclosed.

Although various illustrative embodiments are described above, any of anumber of changes may be made to various embodiments without departingfrom the scope of the invention as described by the claims. For example,the order in which various described method steps are performed mayoften be changed in alternative embodiments, and in other alternativeembodiments one or more method steps may be skipped altogether. Optionalfeatures of various device and system embodiments may be included insome embodiments and not in others. Therefore, the foregoing descriptionis provided primarily for exemplary purposes and should not beinterpreted to limit the scope of the invention as it is set forth inthe claims.

The examples and illustrations included herein show, by way ofillustration and not of limitation, specific embodiments in which thesubject matter may be practiced. As mentioned, other embodiments may beutilized and derived there from, such that structural and logicalsubstitutions and changes may be made without departing from the scopeof this disclosure. Such embodiments of the inventive subject matter maybe referred to herein individually or collectively by the term“invention” merely for convenience and without intending to voluntarilylimit the scope of this application to any single invention or inventiveconcept, if more than one is, in fact, disclosed. Thus, althoughspecific embodiments have been illustrated and described herein, anyarrangement calculated to achieve the same purpose may be substitutedfor the specific embodiments shown. This disclosure is intended to coverany and all adaptations or variations of various embodiments.Combinations of the above embodiments, and other embodiments notspecifically described herein, will be apparent to those of skill in theart upon reviewing the above description.

What is claimed is:
 1. A method of retracting tissue, the methodcomprising: positioning a C-shaped first arm of a retractor assemblyagainst a first portion of a tissue, wherein the C-shaped first armcomprises a plurality of plates extending in parallel along a length ofthe C-shaped first arm; positioning a C-shaped second arm of theretractor assembly against a second portion of the tissue, wherein theC-shaped second arm comprises a plurality of plates extending inparallel along a length of the C-shaped second arm; and ratcheting theC-shaped first arm relative to the C-shaped second arm by pivoting theC-shaped first arm relative to the C-shaped second arm in a plane thatis parallel to the plates forming the C-shaped first arm and engaging aratcheting lock between the C-shaped first arm and the C-shaped secondarm to prevent reduction of an angle between the C-shaped first arm andthe C-shaped second arm until a release is activated, while allowing theangle to be increased.
 2. The method of claim 1, further comprisinginserting one or more tools at least partially into a space formedbetween a first c-shaped plate and a second C-shaped plate forming theC-shaped first arm.
 3. The method of claim 1, wherein the plurality ofplates extending in parallel along the length of the C-shaped first armare each separated from each other by one or more spacing distancesbetween 0.5 mm and 2 cm and the plurality of plates extending inparallel along the length of the C-shaped second arm are each separatedfrom each other by one or more spacing distances between 0.5 mm and 2cm.
 4. The method of claim 1, further comprising releasing theratcheting lock by releasing a first quick release plate disposed alongthe C-shaped first arm and a second quick release plate disposed alongthe C-shaped second arm.
 5. The method of claim 4, wherein releasing theratcheting lock comprises releasing engagement of the first quickrelease plate from a first set of ratchet teeth disposed on a first endof the C-shaped second arm.
 6. The method of claim 4, wherein releasingthe ratcheting lock comprises releasing engagement of the second quickrelease plate from a second set of ratchet teeth disposed on a first endof the C-shaped first arm.
 7. The method of claim 4, wherein releasingthe ratcheting lock comprises driving the first quick release plateagainst a bias and away from a set of ratchet teeth.
 8. The method ofclaim 4, wherein releasing the first quick release plate comprisessliding the first quick release plate between the plates forming theC-shaped first arm.
 9. The method of claim 1, further comprisingengaging a tool in one or more receiving wells in the C-shaped first armand/or the C-shaped second arm.
 10. The method of claim 1, furthercomprises coupling a retractor blade to a distal end of the C-shapedfirst arm.
 11. A method of retracting tissue, the method comprising:positioning a C-shaped first arm of a retractor assembly against a firstportion of a tissue, wherein the C-shaped first arm comprises a firstplate and a second plate that are separated from each other by a firstspacing distance and wherein the first plate and the second plate extendin parallel along a majority of a length of a C-shape of the C-shapedfirst arm; positioning a C-shaped second arm of the retractor assemblyagainst a second portion of the tissue, wherein the C-shaped second armcomprises a third plate and a fourth plate that are separated from eachother by a second spacing distance, wherein the third plate and thefourth plate extend in parallel along a majority of a length of aC-shape of the C-shaped second arm; and ratcheting the C-shaped firstarm relative to the C-shaped second arm by pivoting the C-shaped firstarm relative to the C-shaped second arm in a plane that is parallel tothe first plate, the second plate, the third plate and the fourth plate,and engaging a ratcheting lock to prevent reduction of an angle betweenthe C-shaped first arm and the C-shaped second arm until a release isactivated, while allowing the angle between the C-shaped first arm andthe C-shaped second arm to be increased.
 12. The method of claim 11,further comprising inserting one or more tools at least partially into aspace formed between a first c-shaped plate and a second C-shaped plateforming the C-shaped first arm.
 13. The method of claim 11, furthercomprising releasing the ratcheting lock by releasing a first quickrelease plate disposed along the C-shaped first arm and a second quickrelease plate disposed along the C-shaped second arm.
 14. The method ofclaim 13, wherein releasing the ratcheting lock comprises releasingengagement of the first quick release plate from a first set of ratchetteeth disposed on a first end of the C-shaped second arm.
 15. The methodof claim 13, wherein releasing the ratcheting lock comprises releasingengagement of the second quick release plate from a second set ofratchet teeth disposed on a first end of the C-shaped first arm.
 16. Themethod of claim 13, further wherein releasing the ratcheting lockcomprises driving the first quick release plate against a bias and awayfrom a set of ratchet teeth.
 17. The method of claim 11, wherein thefirst and second spacing distances are between 0.5 mm and 2 cm.
 18. Themethod of claim 11, further comprising engaging a tool in one or morereceiving wells in the C-shaped first arm and/or the C-shaped secondarm.
 19. The method of claim 11, wherein positioning the C-shaped firstarm of the retractor assembly against the first portion of a tissuefurther comprises engaging a retractor blade at a distal end of theC-shaped first arm against the first portion of the tissue.
 20. A methodof retracting tissue, the method comprising: positioning a firstretractor blade at a distal end of a C-shaped first arm of a retractorassembly against a first portion of a tissue, wherein the C-shaped firstarm is formed of at least two plates extending in parallel along alength of the C-shape; positioning a second retractor blade at a distalend of a C-shaped second arm of the retractor assembly against a secondportion of the tissue, wherein the C-shaped second arm is formed of atleast two plates extending in parallel along a length of the C-shape;ratcheting the C-shaped first arm relative to the C-shaped second arm bypivoting the C-shaped first arm relative to the C-shaped second arm in aplane that is parallel with the plates forming the C-shaped first armand the C-shaped second arm; and engaging a ratcheting lock to preventthem from reducing an angle between the arms until a release isactivated, while allowing the angle between the C-shaped first arm andthe C-shaped second arm to be increased.